DVBCDHCK ;ALB/GTS-557/THM-DISEASES OF THE HEART ; 3/14/91 10:12 AM ;;2.7;AMIE;;Apr 10, 1995 ; S PG=1,HD91="Department of Veterans Affairs" S HD9=$S($D(CMBN):"Abbreviated",1:"Full")_" Exam Worksheet" EN D:'$D(IOF) SETIOF W:(IOST?1"C-".E) @IOF W !?25,HD91,!?22,"Compensation and Pension Examination",! W ?33,"# 0110 Worksheet" S HD7="DISEASES OF THE HEART (CARDIOVASCULAR)",HD8="For "_HD7 W !?(40-($L(HD9)\2)),HD9,!?(40-($L(HD8)\2)),HD8,!! W !,"Name: ",NAME,?45,"SSN: ",SSN,!?45,"C-number: ",CNUM,!,"Date of exam: ____________________",!!,"Place of exam: ___________________",!!,"Type of Exam: ",?14,HD7 W !!!!,"Narrative:" W ?13,"In developing the diagnosis of a cardiac condition, the",!?13,"NOMENCLATURE AND CRITERIA FOR DIAGNOSIS OF DISEASE",! W ?13,"OF THE HEART published by the New York Heart Association",!?13,"serves as an acceptable standard. If a stress test",! W ?13,"could be conducted without cardiovascular contraindications",!?13,"but physical problems preclude, please state.",!! I '$D(CMBN) W "A. Medical history:",!!!!!!!!!!,"B. Subjective complaints:",!!!!!!!!!!,"C. Objective findings:",!!!!!!!!!! D HD2 W $S($D(CMBN):"A. ",1:"D. "),"Specific evaluation information required by the rating board",!?4,"(if the information requested is included elsewhere, do not",!?4,"repeat here):",!!! W ?8,"1. Blood pressure -",!!!!!!?8,"2. Electrocardiogram -",!!!!!!?8,"3. X-Ray results -",!!!!!! W ?8,"4. Stress test (after EKG, if indicated) -",!!!!!! I $D(CMBN) D HD2 W $S($D(CMBN):"B. ",1:"E. "),"Diagnostic/clinical test results:",!!!!!!!!!! D:$Y>50 HD2 W $S($D(CMBN):"C. ",1:"F. "),"Diagnosis:",!!!!!!!!!!?25,"Signature: ______________________________",!!?30,"Date: _________________________",! K LN,LN1,LN2 Q ; HD2 S PG=PG+1 W @IOF,!,"Page: ",PG,!!,"Compensation and Pension Exam for "_NAME,!,HD8,!!! Q ; SETIOF ; ** Set device control var's D HOME^%ZIS Q